November 28, 2013

Outcomes of Simultaneous Liver and Kidney Transplantation in Relation to a High Level of Preformed Donor-Specific Antibodies

Leca N, Warner P, Bakthavatsalam R, Nelson K, Halldorson J, Rayhill S, Kendrick E, Davis C, Reyes J.   Transplantation.   2013 Nov 27;96(10):914-8

Liver transplants rarely experience antibody-mediated rejection, and it has been suggested that a liver transplant can protect the kidney if a simultaneous transplant is performed. In this single-center study, patients who received a simultaneous liver-kidney transplant had a higher risk of acute rejection, but similar renal function and patient and graft survival, whether or not […]

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November 28, 2013

Cardiovascular Death in Kidney Recipients Treated With Renin-Angiotensin System Blockers

Opelz G, Döhler B.   Transplantation.   2013 Nov 19;

ACE-I inhibitors and ARBs are first-line treatment for patients with glomerular renal diseases, such as diabetes mellitus. Their role in transplantation is not as clear-cut, since the major renal histologic changes are primarily interstitial and vascular. Randomized controlled trials have not found a benefit in renal graft survival with RAS blockade but two small RCTs […]

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November 28, 2013

Class II HLA Epitope Matching—A Strategy to Minimize De Novo Donor-Specific Antibody Development and Improve Outcomes

Wiebe C, Pochinco D, Blydt-Hansen TD, Ho J, Birk PE, Karpinski M, Goldberg A, Storsley LJ, Gibson IW, Rush DN, Nickerson PW.   Am J Transplant.   2013 Dec;13(12):3114-22

Although testing for HLA antibodies is long-established practice in transplantation, the immune system actually makes antibodies against specific epitopes, not antigens. This study used the HLA Matchmaker program to assess whether the degree of epitope mismatching predicted the development of post-transplant class II donor-specific antibodies. Thresholds for epitope mismatching at DR and DQ were found. […]

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November 28, 2013

Planned Randomized Conversion From Tacrolimus to Sirolimus-Based Immunosuppressive Regimen in De Novo Kidney Transplant Recipients

Silva HT Jr, Felipe CR, Garcia VD, Neto ED, Filho MA, Contieri FL, de Carvalho DD, Pestana JO.   Am J Transplant.   2013 Dec;13(12):3155-63

While sirolimus has some features that make it an attractive immunosuppressant, it is less effective at preventing acute rejection than calcineurin inhibitors (CnI). An alternate strategy is to use CnI early post-transplant and then switch to sirolimus at some point post-transplant. In this randomized controlled trial, patients with good graft function and no other contraindications […]

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October 25, 2013

Microarray Diagnosis of Antibody-Mediated Rejection in Kidney Transplant Biopsies: An International Prospective Study (INTERCOM)

Halloran PF, Pereira AB, Chang J, Matas A, Picton M, De Freitas D, Bromberg J, Serón D, Sellarés J, Einecke G, Reeve J.   Am J Transplant.   2013 Nov;13(11):2865-74

Although considered the gold standard, histologic examination of renal transplant biopsies, expert pathologists frequently disagree on their interpretation of the same sample. The authors of this paper have developed criteria for antibody-mediated rejection based on mRNA expression in biopsy samples detected by microarrays. In this study, they validate their previous findings in a cohort of […]

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October 25, 2013

Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients

Renal transplantation for carefully selected HIV-positive patients has become well-accepted over the last decade. There remain concerns about the risk of overimmunosuppression in this group, due to their pre-existing immunodeficiency due to HIV infection. In this US registry study, HIV-positive patients actually had a higher risk of acute rejection than HIV-negative recipients, but this increased […]

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October 25, 2013

The European Renal Best Practice (ERBP) Transplantation guideline development group

European Renal Best Practice Transplantation Guideline Development Group.   Nephrol Dial Transplant.   2013 Aug;28 Suppl 2:ii1-71

These guidelines provide a perspective on appropriate assessment for transplant of both donors and recipients. A detailed, structured plan was followed regarding literature review and grading of the evidence. While the recommendations reflect current knowledge, they also show the areas where expert opinion must be used, and more research is needed.

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October 11, 2013

Complement-binding anti-HLA antibodies and kidney-allograft survival

Loupy A, Lefaucheur C, Vernerey D, Prugger C, Duong van Huyen JP, Mooney N, Suberbielle C, Frémeaux-Bacchi V, Méjean A, Desgrandchamps F, Anglicheau D, Nochy D, Charron D, Empana JP, Delahousse M, Legendre C, Glotz D, Hill GS, Zeevi A, Jouven X.   N Engl J Med.   2013 Sep 26;369(13):1215-26

The study by Loupy et. al. shows an important role for complement-fixing (C1Q+) donor-specific HLA antibodies (DSA) in risk prediction of kidney allograft loss. The study examined 1016 kidney transplant recipients transplanted across negative T- and B-cell cytotoxic crossmatches with subsequent testing by Luminex single antigen beads for the detection of complement-fixing as well as […]

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October 7, 2013

Acute antibody-mediated rejection after lung transplantation

Witt CA, Gaut JP, Yusen RD, Byers DE, Iuppa JA, Bennett Bain K, Alexander Patterson G, Mohanakumar T, Trulock EP, Hachem RR.   J Heart Lung Transplant.   2013 Oct;32(10):1034-40

There is no consensus on the characteristic features of antibody-mediated rejection (AMR) in lung transplantation. This retrospective cohort study characterized the clinical and pathological features of acute AMR after lung transplantation. Twenty-one patients were identified based on the presence of circulating donor-specific antibodies, histologic evidence of acute lung injury, C4d deposition, and clinical allograft dysfunction.

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October 7, 2013

Experience of extracorporeal membrane oxygenation as a bridge to lung transplantation in France

Lafarge M, Mordant P, Thabut G, Brouchet L, Falcoz PE, Haloun A, Le Pimpec-Barthes F, Maury JM, Reynaud-Gaubert M, Saint-Raymond C, Sage E, Stern M, Thomas P, Castier Y, Dorent R, Mal H.   J Heart Lung Transplant.   2013 Sep;32(9):905-13

Extracorporeal membrane oxygenation (ECMO) used as a bridge to lung transplantation in patients failing other means of life support has been disappointing, although many transplant centres continue to explore this technology for this indication. This retrospective multi centre study describes the experience 36 patients in France between 2007 and 2011.

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